MEDICARE: STILLWATER PLASTIC SURGERY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	9700210	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10329	OTHER	NC	BLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number	:	1346205135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLWATER PLASTIC SURGERY, PA

Provider Business Mailing Address
First Line	:	8712 LINDHOLM DR
Second Line	:	SUITE 308
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-1870
Country	:	US
Telephone Number	:	704-655-8988
Fax Number	:	704-655-8980

Provider Business Practice Location Address
First Line	:	8712 LINDHOLM DR
Second Line	:	SUITE 308
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-1870
Country	:	US
Telephone Number	:	704-655-8988
Fax Number	:	704-655-8980

Authorized Official
Title or Position	:	MGR
Name	:	PETER JOSEPH CAPIZZI
Credential	:	MD
Telephone Number	:	704-655-8988

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	11/11/2008

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